Jump to content

Tips 'n Tricks: Pearls the Newbies Need to Know

Posted

Specializes in being a Credible Source. Has 11 years experience.

I've been thinking about what simple advice we could give to those new to our ranks... a bullet list kind of thing... Tips 'n Tricks... Pearls... ED Nurse-Hacks...

Here's the one that I was thinking about that provoked this thread:

~~~~

+ Wear a gown and a face-shield to every trauma, every code, every time.

~~~~

It's much easier to discard PPE that you didn't need than to find a shower, clean scrubs, and time for post-exposure labs after you were inadvertently sprayed with ickiness.

A couple days ago, we ran a code for 30 mins or so on a drowning victim... multiple attempts at multiple lines... fem stick by an intern... vomit... feces... difficult airway... you know the story... so after it's called, several of us are working to get the victim tagged-n-bagged... the attending walks in and, for some unknown reason, presses on the guy's upper abdomen... at which point blood came shooting out of his NPA... all over the tech.

I've seen way too many people get blooded, etc for lack of PPE... and once the whole thing starts, there's no time to get the PPE in place.

It took me quite awhile to adopt this approach because the 'salty' ones didn't do it and I didn't want to look green. Now... I don't give a rip what I look like as long as I don't have blood goobers dripping off of me.

So, ED noobs... PPE for every trauma, every code, every time.

Cheyenne RN,BSHS

Specializes in Med Surg, ICU, Infection, Home Health, and LTC. Has 35 years experience.

***Mask for every intubation.***

You do not want someone calling and telling you that "Oh by the way, that patient you tubed had active TB and end stage AIDS."

livingthedream77

Specializes in ER.

*unless they've had a hyster, get the pregnancy test

*don't let them scare you with "oh, they can never get an IV/my veins roll/you have to use a butterfly/you only get one stick". Sometimes, it takes more than one stick, especially if they are oh, I don't know, SICK. Make it clear when you start.

*memorize this phrase: "patients are seen in order of severity of symptoms, not arrival time"

*if a person is ma'am/sir -ing you to death, being hyper-respectful: ask if they are ex-military, or from the South. If no to both, this MAY be a sign they are drug seeking. Has turned out that way too many times to ignore the trend

*who gets an EKG? Anyone with CP, SOB, pain in jaw/neck/arm/back, dizzy. lighthead, unexplained weakness, diaphoretic. In short, if they have even one symptom, get it the EKG, rule it out. Had 30yo F and 27yo M no hx, no drugs, nothing....chief c/o "my chest is a little tight feeling" .....STEMIs.

And a lesson from this shift: keep a complete change of uniform, including shoes and socks, in your locker. You never know when some drunk may pee on your leg and into your shoe.

Nonyvole, BSN, RN

Specializes in Emergency.

Sometimes the frequent flyers really are sick and not just lonely/drug seeking/attention-seeking.

Running to anything just makes you out of breath. Walking quickly not so much...and less risk of you falling.

Even if it isn't up to you to stock rooms, make sure that they're all stocked to your satisfaction at the beginning of your shift. Nothing worse than opening up the cupboard for a basin for the patient to puke in only to discover that they weren't stocked and whoops, now they need a linen change, the floor needs mopping, and oh, they really were puking up bright red blood...

There is no shame in, if there are no patients, turning on music and rocking out. Sometimes the patients would actually like that better than sitting in their rooms on their psych holds.

Patients are sick. Expect to treat them like you would treat a sick child (with care, and without complaining you didn't go to nursing school to be a waitress.) They also have their own issues, and it's compounded with being sick/injured. If you're having trouble having compassion, find a therapist and work on it. Both you and your patients will enjoy your shifts together more.

And if any personality conflicts come up with other nurses that you can't resolve, address them with your manager and HR if necessary. Don't let someone's bad attitude push you out of a job you'd otherwise like to keep.

motherof3sons

Specializes in LTC. Has 22 years experience.

People who feel bad-- act bad---whether it is physical or emotional. That phrase alone helps me tolerate less than polite, nice people and makes me change my approach.

delphine22

Specializes in Quality, Cardiac Stepdown, MICU. Has 5 years experience.

People who feel bad-- act bad---whether it is physical or emotional. That phrase alone helps me tolerate less than polite, nice people and makes me change my approach.

This.^^

I try to always tell myself, no matter how bad my day is going, theirs is worse. I've only been in the hospital twice, to give birth. I've never been sick enough to be hospitalized. To be that sick has got to be in the top 10 worst days of someone's life.

No matter what, at the end of my shift, I clock out, go home, get to shower and sleep in my own bed, eat what/when I want, and cuddle my loved ones. They don't. So in my book, they get a pass. (Of course obviously, physical and outright verbal abuse/cussing is not OK. But I let snippiness roll right off me.)

I kept emergency food in my locker all the time, mostly not for me, but for my CNAs, who often got mandated to work a double shift and had no way to get food. If I had 2 or more people working doubles, we ordered pizza :) I always made sure everybody took their breaks and had stuff to eat.

I used to be one of those people who worked through all their breaks, clocked out, and did my charting. Times have changed. I also figured out that the more tired you are, the slower you go. Taking your break and catching your breath probably doesn't take any more time than working at the speed of snail. You have to take care of yourself (and your staff), as your corporate masters are not going to.

joyful_wanderer

Specializes in ER, PACU, ICU. Has 6 years experience.

If you have long hair always keep it up and out of the way. Even if its 9 minutes to shift change and the ER is quite don't let your hair down. Because when you do the only patient in the ER that does not have an IV will start seizing and not stop. In other words: always be ready for anything

Edited by joyful_wanderer

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience.

If you think they need line & lab, do it now.

Use your standing protocols (see above).

Don't grab the doc for every pt. Only those where YOU'RE tachy, diaphoretic and the hair on the back of your neck is standing up.

Sassy5d

Has 11 years experience.

Pretend everyone has AIDS. We've all heard it but quite frankly, many have no idea and other's just don't want to bother to tell you..

TexanTough

Specializes in Emergency Nursing, Critical Care Nursing. Has 7 years experience.

-You can't dilute valium.

-If families are going to be in a room with a patient and are capable, utilize them to assist with the patient's care.

-Label your meds as you draw them up. Which syringe is zofran? Which syringe is 2mg Dilaudid?

-Don't be timid or a doormat. Be assertive if you are advocating for a patient (especially in a teaching hospital environment).

-Know your stuff. This comes with time, but if you have a question, ask a provider. Don't ever say "I don't need to know that." You never know when your clinical proficiency will prevent a provider from killing someone.

-Along the same lines as above, if you don't know something...ASK. A great approach is to say, "refresh my memory on ____" if you feel intimidated because you don't know something.

Pixie.RN, MSN, RN

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 13 years experience.

Bring a protein shake - it is easier to drink some basic nutrition than it is to try to eat something fast with your hands.

Keep spare scrubs/socks/shoes/underthings in your car or locker. One complete set.

Pee when you can, because if you put it off, it'll be 6 more hours until you get a chance.

You can make a "smellulizer" with a nebulizer, hand sanitizer, and a little water. That mist can de-funk a recently vacated room.

Sodium bicarb will neutralize stinky feet.

Don't underestimate the power of a warm blanket.

Be kind, even in the face of unkindness. It's rarely personal.

I'm a newbie, but I've already learned the values of nursing shoes. The blood wipes right off! I was drenched by a trauma patient while transferring him from the ER. I was so glad I wasn't in my $140 running shoes...

When giving a call light, consider saying something like, "Please call me if you're having an emergency, or you feel chest pain, shortness of breath or...(specifics) and otherwise I will be rounding".

I am happy to help my patients, I do have compassion, but I absolutely must prioritize and cannot be adjusting blankets and beds every five minutes for one patient. One q5 minute call light user (I want up, down, new blankets, etc.) patient informed me, "But you are HERE, for my comfort". I replied, "I am here for emergencies first, then health and safety, and then comfort.

Julia

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

People who feel bad-- act bad---whether it is physical or emotional. That phrase alone helps me tolerate less than polite, nice people and makes me change my approach.

And then there are those who act bad just on general principles.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

If you have a trauma coming in, go pee. You may be busy for the next 3-6 hours, or more.